Central scotoma after indocyanine green assisted fovea-sparing internal limiting membrane peeling

Purpose: To report a case with myopic traction maculopathy (MTM) that underwent fovea-sparing internal limiting membrane (ILM) peeling and developed a central scotoma with a nasal visual field defect postoperatively.

Observations: A 63-year-old man diagnosed with foveoschisis and a small outer lamellar macular hole underwent 25-gauge, 3-port pars plana vitrectomy and fovea-sparing ILM peeling using indocyanine green (ICG) staining. One year after the vitrectomy, optical coherence tomography (OCT) revealed a resolution of the macular retinoschisis and an intact ellipsoid zone at the fovea. However, macular edema was present over the area of the residual ILM, and the visual acuity had worsened to 20/200. Goldmann perimetry showed a central scotoma and a constriction of the nasal visual field. OCT angiography detected abnormal blood flow in the inner retina corresponding to the area of the residual foveal ILM. The multifocal electroretinograms were reduced in the central area.

Conclusion: The findings suggest that functional abnormalities of the fovea induced by ICG toxicity may have been manifested by a central scotoma. Therefore, surgeons need to consider the toxic effects of dyes such as ICG.

Keywords: Central scotoma; Fovea-sparing internal limiting membrane peeling; Indocyanine green; Myopic traction maculopathy; Postoperative visual field defect.